Gastrointestinal Emergencies pp 463-465 | Cite as
How Do I Approach Pain or Bleeding After Colonoscopy?
Abstract
Colonoscopy utilization has increased significantly over the last 10 years; therefore, acute care providers must be prepared to evaluate and manage complications from this procedure. Major complications include perforation, post-polypectomy syndrome, and bleeding. Perforation, while rare, is a potentially serious complication. It can present with pain (local or generalized), peritonitis, or even frank sepsis/shock. Pain without findings of perforation is the hallmark of post-polypectomy syndrome. Bleeding after colonoscopy is frequently minor and self-limited, but because severe bleeding can occur, patients often require admission for monitoring and repeat colonoscopy for hemostasis.
Keywords
Colonoscopy Complications Perforation Post-polypectomy syndrome Hemorrhage Lower gastrointestinal bleedingReferences
- 1.Lieberman DA, Williams JL, Holub JL, Morris CD, Logan JR, Eisen GM, et al. Colonoscopy utilization and outcomes 2000 to 2011. Gastrointest Endosc. 2014 Jul;80(1):133–43.CrossRefGoogle Scholar
- 2.U.S. Preventive Services Task Force. Screening for colorectal cancer: recommendation statement. Am Fam Physician. 2017;95(4). Available from: http://www.aafp.org/afp/2017/0215/od1.html.
- 3.Lin JS, Piper MA, Perdue LA, Rutter CM, Webber EM, O’Connor E, et al. Screening for colorectal Cancer: updated evidence report and systematic review for the US preventive services task force. JAMA. 2016;315(23):2576–94.CrossRefGoogle Scholar
- 4.Ko CW, Riffle S, Michaels L, Morris C, Holub J, Shapiro JA, et al. Serious complications within 30 days of screening and surveillance colonoscopy are uncommon. Clin Gasteroentrol Hepatol. 2010;8(2):166–73. https://doi.org/10.1016/j.cgh.2009.10.007.CrossRefGoogle Scholar
- 5.Louise W, Ajitha M, Gurkirpal S, Uri L. Low rates of gastrointestinal and non-gastrointestinal complications for screening or surveillance colonoscopies in a population-based study. Gastroenterology. 2018;154(3):540.e8–55.e8. https://doi.org/10.1053/j.gastro.2017.10.006.CrossRefGoogle Scholar
- 6.ASGE Standards of Practice Committee, Fischer DA, Maple JT, Ben-Menachem T, Cash BD, Decker GA, Early DS, et al. Complications of colonoscopy. Gastrointest Endosc. 2011;74(4):745–52. https://doi.org/10.1016/j.gie.2011.07.025.CrossRefGoogle Scholar
- 7.Levin TR, Zhao W, Conell C, Seeff LC, Manninen DL, Shapiro JA, et al. Complications of colonoscopy in an integrated health care delivery system. Ann Intern Med. 2006;145(12):880–6. https://doi.org/10.7326/0003-4819-145-12-200612190-00004.CrossRefPubMedGoogle Scholar
- 8.Arora G, Mannalithara A, Singh G, Gerson LB, Triadafilopoulos G. Risk of perforation from a colonoscopy in adults: a large population-based study. Gastrointest Endosc. 2009;69(3):654–64. https://doi.org/10.1016/j.gie.2008.09.008.CrossRefPubMedGoogle Scholar
- 9.Garbay JR, Suc B, Rotman N, Fourtanier G, Escat J. Multicentre study of surgical complications of colonoscopy. Br J Surg. 1996;83(1):42–4. https://doi.org/10.1002/bjs.1800830112.CrossRefPubMedGoogle Scholar
- 10.Damore LJ, Rantis PC, Vernava AM, Longo WE. Colonoscopic perforations. Dis Colon Rectum. 1996 Nov;39(11):1308–14. https://doi.org/10.1007/bf02055129.CrossRefPubMedGoogle Scholar
- 11.Green J. Guidelines on complications of gastrointestinal endoscopy. London: Br Soc Gastroenterol. 2006. http://f.i-md.com/medinfo/material/475/4ea7cdb844aebf27f87d9475/4ea7cdb844aebf27f87d9479.pdf.
- 12.Tiwari A, Sharma H, Qamar K, Sodeman T, Nawras A. Recognition of extraperitoneal colonic perforation following colonoscopy: a review of the literature. Case Rep Gastroenterol. 2017;11(1):256–64. https://doi.org/10.1159/000475750.CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Johnson H. Management of major complications encountered with flexible colonoscopy. J Natl Med Assoc. 1993;85(12):916–20. PMID:8126742PubMedPubMedCentralGoogle Scholar
- 14.Byeon JS. Colonic perforation: can we manage it endoscopically? Clin Endosc. 2013;46(5):495–9. https://doi.org/10.5946/ce.2013.46.5.495.CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Raju GS, Saito Y, Matsuda T, Kaltenbach T, Soetikno R. Endoscopic management of colonoscopic perforations (with videos). Gastrointest Endosc. 2011;74(6):1380–8. https://doi.org/10.1016/j.gie.2011.08.007.CrossRefGoogle Scholar
- 16.Singaram C, Torbey CF, Jacoby RF. Delayed postpolypectomy bleeding. Am J Gastroenterol. 1995;90(1):146–7. PMID: 7801918PubMedGoogle Scholar